Provider Demographics
NPI:1801054895
Name:AUNDREYS RESIDENTIAL CARE INC.
Entity type:Organization
Organization Name:AUNDREYS RESIDENTIAL CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:BS,
Authorized Official - Phone:818-585-7956
Mailing Address - Street 1:5740 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1406
Mailing Address - Country:US
Mailing Address - Phone:818-758-0196
Mailing Address - Fax:818-758-0358
Practice Address - Street 1:8335 WINNETKA AVE # 162
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-1630
Practice Address - Country:US
Practice Address - Phone:818-758-0196
Practice Address - Fax:818-758-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
385H00000X
CA197607102311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care